Historic day for health care

Despite incurable obstruction from far-right House Republicans, a historic day in the transformation of U.S. health care has arrived.

Beginning today, individuals may sign up for private health insurance that will be available on government-run exchanges. Actual coverage will begin Jan. 1 but the enrollment period will be open through March 1, 2014. In Pennsylvania, the Corbett administration refused to establish a state-level insurance exchange, so the exchange serving Pennsylvanians will be run by the federal government. It's online at www.healthcare.gov.

Detailed information on plans offered in Pennsylvania will be available on the site. No advanced information on pricing was available on the federal change, but several states that chose to operate their own exchanges, including New York and California, have released information showing premium rates substantially lower than had been forecast - up to 50 percent in some cases.

The Affordable Care Act requires everyone to obtain coverage - the "individual mandate" that was upheld by the Supreme Court - or to pay a penalty of up to 1 percent of income.

Mandatory coverage is necessary to pay for the many improvements under the law, some of which already are in place. Insurers no longer may reject or terminate coverage for a pre-existing condition, for example, and young people may remain under their parents' coverage until their 26th birthday.

In Northeastern Pennsylvania the law is expected to reduce the number of uninsured people by about 56 percent, but that includes the assumption that the state ultimately will expand the state/federal Medicaid program to cover low-income workers. The Corbett administration, which began with elimination of the state adultBasic program, which already covered many of those workers, has resisted Medicaid expansion even though it would be a good deal for the state. It has proposed a more costly and less efficient alternative.

The ACA, or "Obamacare," is the result of a tortured compromise in Congress and, therefore, is far from perfect. But, just as Medicare often has been refined, the ACA can be adjusted to experience in the markets. That's what ACA opponents in Congress should do instead of paralyzing the government over the fantasy that the law will be repealed before it's implemented. Obamacare is here to stay. The objective should be to make it as effective as possible.

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